World Antibiotics Awareness Week

Theresa Villiers Excerpts

Thursday 16th November 2017 Westminster Hall

[Theresa Villiers (Chipping Barnet) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing a debate on such an important issue.

As we heard in my hon. Friend’s powerful speech, antimicrobial resistance is a significant and increasing public health threat both here and in the rest of the world. It is estimated that, in the United States and Europe alone, antimicrobial-resistant infections currently cause at least 50,000 deaths a year. We can be proud of the fact that the UK Government have played a world-leading role on this issue. David Cameron was one of the first leaders to put it firmly on the international agenda when he launched the review led by Lord O’Neill in 2014.

Despite that determination and commitment, the effective work that the Government are already engaged in and commitments from many other Governments around the world, I am worried that progress is not fast enough, given the seriousness of the risks we now face. Antibiotics have saved countless lives in the 80 or so years since Alexander Fleming’s historic discovery. Ever since their use became widespread in the 1940s, they have ensured that life-threatening infections can be treated effectively and operations that would have previously been very dangerous can be performed safely. Research indicates that the use of antibiotics has probably extended our average life expectancy by around 20 years.

The consequences of antimicrobial resistance are often portrayed as a future threat, but the World Health Organisation is clear that antimicrobial resistance is already detected in all parts of the world and is already causing serious harm. Across the member states of the European Union, it is estimated that AMR currently costs around €1.5 billion in additional healthcare costs and productivity losses.

Those rather dry sounding points can hide the scale of the potential horror we face. The O’Neill review concluded that more than 300 million people are expected to die prematurely because of drug resistance over the next 35 years. As we heard from my hon. Friend, we could see a return to the days when straightforward operations and minor injuries can routinely result in death and childhood mortality is commonplace.

The chief medical officer, Professor Dame Sally Davies, has rightly described AMR as a “catastrophic threat”. She has warned of a “post-antibiotic apocalypse”, where 40% of the population die prematurely from infections that we cannot treat. In her view, that could amount to nothing less than

“the end of modern medicine.”

The worst-case scenarios are frightening. It is therefore vital that we take action to address the threats we face.

We clearly need to improve infection control, not only in our healthcare facilities here but around the world, and I urge the Minister to make AMR, improving sanitation and infection control a priority for our overseas aid projects. We need to bring an end to the over-prescribing of antibiotics in human medicine. That means doing much more to raise public awareness of this issue, so that more people understand the consequences of demanding antibiotics from their GP even when there is not clear evidence that they are needed or justified. It is imperative that we develop better and more accurate ways to diagnose conditions so that we no longer see so many instances of antibiotics being used in cases of viruses and other conditions where they have no effect.

As my hon. Friend the Member for York Outer said, it is crucial that we take action to end the overuse of antibiotics in agriculture. According to a letter from senior medics to the Department for Environment, Food and Rural Affairs in 2016, an astonishing 90% of all UK veterinary antibiotic use is for mass medication of groups of farm animals. As we reflect on reform of our agricultural support system in preparing to leave the European Union, the new system of farm support that we introduce must discourage intensive farming practices where animals are kept in overcrowded, unnatural and unhealthy conditions, which leads to routine prophylactic use of antibiotics. We should be promoting much more health-oriented methods of farming. It is possible to maintain a successful farming sector and at the same time significantly reduce levels of antibiotic use, and we have already seen progress in that direction, particularly in the poultry sector.

We need to ensure that we give priority to this area in Government spending on research and development as part of efforts to expand the pool of effective antibiotics. I agree that we should seek a new approach to rewarding and incentivising medical research in this area as a further means to drive forward the search for effective antibiotics. We need also to significantly improve our knowledge and understanding of the scale of antibiotic use and the threat posed by AMR in this country and around the world.

The O’Neill report made 10 recommendations, and I would welcome an update from the Minister today on the progress made on delivering those. I also urge him to make tackling antimicrobial resistance a key element of our public health policy. I hope the Government will press NHS England, local clinical commissioning groups and local authorities to make it a focus of their sustainability and transformation plans. Moreover, tackling AMR should be an important element of our foreign policy and our international aid budget, because it is self-evident that we cannot solve this problem without concerted action on a global basis.

In conclusion, there are many impassioned debates in the House on different subjects, all of which no doubt seem worth while and important at the time. However, there can be few issues of such huge significance as the one we are considering. If we fail to take action and future generations find their lives blighted by the post-antibiotic apocalypse predicted by the chief medical officer, they will look back on debates such as this and their judgment will not be kind. I say to the Minister and to each and every Member of the House that we need to take action now on antimicrobial resistance if we are to safeguard the health and wellbeing of future generations. I urge the Minister to take that message back to his colleagues in Government.

[Jeremy Lefroy (Stafford) (Con)]

It is a great honour to follow my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) and my hon. Friend the Member for York Outer (Julian Sturdy) in this extremely important debate. As my right hon. Friend said, this issue is both important and urgent; it is not something that we can put off.

I declare my interests as a trustee of the Liverpool School of Tropical Medicine, which does research in this area, and as chair of the all-party parliamentary group on malaria and neglected tropical diseases, the significance of which I shall come to in a moment.

Both previous speakers outlined the importance of this subject. The O’Neill report said that we are looking at the possibility of 10 million deaths a year and the loss to global GDP. However, I do not want to dwell on that, because I want to talk about how we can make progress. We have to make progress because at the moment it is too slow. As the chief medical officer, Professor Dame Sally Davies, has said, we do not have time. “The Drugs Don’t Work”, to quote the title of her book.

There are four areas in which we need to make some progress. I do not claim any innovation in this. I listened to a lecture on the issue just last week and these were the four areas set out; I am just repeating what I have heard. The four areas are public education, drug discovery, the involvement of drug companies, and financial mechanisms such as advance market commitments. I shall take them in turn.

First, on public education, it is extremely important that we work together, that we bring the public with us. This country has had a great record over the years in preserving antibiotics for the most essential use, at least in relation to human health. My right hon. Friend described the problems in the animal health sector, but in the area of human health, we have preserved antibiotics. Compared with most countries in the world, we are extremely prudent in our use: doctors do not prescribe them unless they are really needed.

We can do more, however. We can involve the public—citizens—in the search for new antibiotics. I was introduced last week to a great scheme called Swab and Send, which can be looked up on the internet and which is run out of the Liverpool School of Tropical Medicine now. For a small amount—I think it is £30—people get five swab kits. They are encouraged to send in dust samples or whatever; they are encouraged to swab anywhere in their house where they think interesting cultures might be building up and to send the samples in to be tested in laboratories. I saw some of the results. Young people, children and adults all around the country are sending swabs to Liverpool for them to be tested and cultured to see whether potential new antibiotics can come out of that. The reason for doing it is that, just as with the fortuitous discovery of penicillin, we have, potentially, the answer—it could even lie somewhere in a corner of this room. We do not know, but let us get citizens involved in sending those samples in from all over the country and, indeed, the world and get them tested. We have an army of volunteer scientists and researchers out there who are able to help us to discover the next generation of antibiotics.

The second area is drug discovery. We have heard that it has been extremely difficult to make progress in drug discovery, for a number of reasons. I believe that the last major development was 30 years ago, so we have not had a new antibiotic for 30 years. The problem is that antibiotics are cheap. When drugs are cheap but developing them is expensive—it takes years, we have heard 15 years, and the cost can be in the hundreds of millions of pounds —it is simply not commercially possible for drug companies to engage in this kind of research and development. It needs a combination of public finance and private development and initiative.

At this point, I want to reflect on what has happened in relation to malaria, which I know a little about, over the last 16 or 17 years. The Medicines for Malaria Venture is a fine example of how we can have international co-operation. It supports pharmaceutical companies to develop new medicines for malaria that would not be able to be produced commercially. Seventeen years ago, in 2000, as I know myself having contracted the disease a number of times, the efficacy of standard treatments for malaria was poor, or they were pretty toxic. Resistance to chloroquine, which was the main drug, was high everywhere. Sulfadoxine-pyrimethamine, or SP, which had replaced chloroquine as the main drug in a number of places, was also becoming less effective. New drugs, based on the Artemisia annua plant, were emerging, but much more work needed to be done on them. Drugs were available, but they were not particularly well developed, and because they were single therapies, not combination therapies, there was the great risk that resistance to them would occur very quickly.

The Medicines for Malaria Venture was set up with the specific aim of working with companies to bring potential drugs through research and development to the market. I am proud to say that, since 1999, the United Kingdom has been the second largest provider of funding to that excellent organisation after the Bill & Melinda Gates Foundation, which has funded more than half the total expenditure since then, which is something like $1 billion.

What have we seen as a result of the $1 billion of expenditure over 17 years? We have seen a transformation. In 2000, there were 10 products around and being worked on: six at the research stage and four at the translational stage. There was none at the product development stage and none on the market. Where are we now, 17 years later? There are 21 in research, nine at the translational stage, seven at the product development stage and 10 on the market. That is a huge return on investment. Obviously, it was not just the investment of the $1 billion or so with MMV; it was also investment by private companies working alongside MMV that put a lot of their own money into it.

Now, therefore, we have not only a good range of very effective drugs available globally that have saved millions of lives—one estimate is 6 million; it is possibly more than that—but a very healthy pipeline: 30 drugs at the research and translational stages and another seven at the product development stage. That is exactly what we need to see for antibiotics, and not just in the future but now. There we have a model. It may not be exactly the right model for antibiotics, but it is a model. That shows that it can work and not just in relation to malaria drugs; we have seen it work in relation to drugs for so-called neglected tropical diseases. An equivalent organisation is bringing forward drugs in that area. We have seen it with vaccines. The world has come together to produce better vaccines or more vaccines to cover more diseases through the Global Alliance for Vaccines and Immunisation.

We therefore have models for drug discovery, but we need to ensure that they involve the drug companies. This cannot be done just by the public sector. The drug companies have enormous expertise and great researchers; they just need the incentive to work on the development of new antibiotics to a much greater extent. We are not talking about doing one or two; we are talking about looking at dozens and dozens. That is why it needs a co-ordinated and global approach. I think the drug companies are willing. They are out there, they are able to do it and they want to do it; they just need a bit of co-ordination and incentive—a bit of a push—and also the public encouragement that comes from knowing that this is something that we all want to do and that will benefit the entire world.

We need to look at how that finance could be introduced. I have talked about advance market commitments. That is the possibility that has been suggested to me. It has been done before. Just over a decade ago, advance market commitments were developed for vaccines. We have vaccines available around the world now, inoculating children and preventing them from getting debilitating or killer diseases, because of the commitment made by our Government in 2005-06 and other Governments, with again the UK taking the lead. That is an area in which we have expertise and have already shown commitment. Therefore, it is absolutely right, as my hon. Friend the Member for York Outer and my right hon. Friend the Member for Chipping Barnet have said, that the UK should be taking a lead in this. At this time, when perhaps our global position is changing, what could be better than showing global leadership in an area that is of great benefit to all humanity and showing that global Britain is a reality, not just a form of words?

Just a few words on how advance market commitments work. In the case of vaccines—there is no reason why it could not work in the same way for antibiotics—there is an agreement for money to subsidise the purchase of a future drug at a given price, so that people know that they are going to sell that drug at a certain price, which means that they can invest in the research and development. That gives manufacturers the incentive to invest not only in that R and D, but in capacity. We need to build that capacity. Clearly, in the case of vaccines, that was enormous because vaccine plants are extremely expensive; in the case of antibiotics, the expense would be less, but nevertheless significant. Then there is the agreement that, once a fixed amount of sales, in terms of numbers or value, has been reached, the manufacturer is contractually obliged to sell the drugs affordably in the markets or to license the technology. Let us be frank: these drugs are not going to make large sums of money for people. They have to be available at prices that everybody in the world, whether they get them through a health system or purchase them individually, can afford.

[Theresa Villiers]

Listening to my hon. Friend’s speech, it occurs to me that, in other areas of medical research, we see a hugely positive impact from the charitable sector. Should we be trying to read across the lessons from other areas of medical research and to get these fantastically successful charities involved in raising money for AMR research?

[Jeremy Lefroy]

My right hon. Friend is absolutely right. I referred earlier to the involvement of the Bill & Melinda Gates Foundation in the setting up of MMV, but there are so many other medical charities putting millions and sometimes tens of millions of dollars into these areas. That is the beauty of partnerships such as MMV, the Drugs for Neglected Diseases initiative and other partnerships: they take money from the commercial sector, charities, non-governmental organisations and from Government and everybody is working together—they are not in competition with each other over relatively scarce resources. The partnerships are using the benefits, in the case of companies, of their researchers and facilities; in the case of foundations, of their contacts, ability to deploy drugs on the ground and funding; and in the case of Governments, of the substantial funding that they can put in.

I want to conclude by saying that this is not pie in the sky—this is something we can do. We have proven in the case of malaria and other diseases that we can achieve tremendous results. We know there is a will. We know Government have a will. We know there is a will in other countries. It just needs a lot more urgency and more co-ordination. If the UK, through the Department of Health, and as my hon. Friend the Member for York Outer has said, through the co-ordination of the various Departments, were to take this by the scruff of the neck, we would have something by which the UK could again show world leadership not just in words, but in actions. I look forward to hearing from the Minister the plans that we have in that area.